The URL can be used to link to this page

31305APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPERTINO - HmLVINt, hLhCJKMAL 31305 BUILDING DIVISION APPLICATION/PERMIT r' PLUMBING -MECHANICAL. ' C -41P . Y(y+J� A �0/J /[/7 ((1TV� Wg&,)d I ❑ Consultant Fees Paid by Applicant (Initial) LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am I eenmd under pr,Asinnx of Chanter 9 (commencing QTY with Section 7000)of Division 3 ofthe Bm,ma,,md Professions Code, my license is in full force and efferr��..�� BUILDING PERMIT INTO License Clues C+Lic. N BLDG ELECT ❑ -5j�, Date�Coutm' r mmds ARCHITECTS JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑KITCHEN REMODEL ❑ADDITION ❑ PLUMBING RE -PIPE , El MULTI -UNIT ❑STRUCTURAL MODIFICATION El INTERIOR ❑CHIMNEY REPAIR IMPROVEMENT ❑ BATH RF,MODEUREPAIR ❑ DEMOLITION ❑ OTHER 1 understand my plans shalt be . d ub Licensed Professional - OWNER -BUILDER DECLARATION I hereby affect that I um exempt from the Contractor's License Law for the following reason, (Section 9831.5, Business Ind Profesalons Code: Any city I,, coall, which requires a Permit to construct, alar, improve, demnlisb, or mpair any streams, poor to its issuance, also requires the applicant for such cand to file a signed smtemem C that he is licensed pursuant u1 time prov axion, of the Cminoulur9 License Law Utopmr 9 (commencing with Section 70(g)) of Division 3 of the Business add Pmfusionv Code) or thin he is exempt therefrom mord the Iasis for the alleged exemption. Any violation of Section 7031.5 by any applicant has permit subjects the applicant to u civil Penalty of not more than five hundred dollars ($50r). [:]has owner of the property, or my employees with wages as their sole compensation, will do me work, and the mtuch re is not intended or offered for sale (Sec. 7044, Business and Pmrexsium Code: The Cnneacon's License Law does not apply man owner of prop,ny who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements an not intended or offend for sale. IL however, the h ddi ag or improvement is sold within one year ol'complmloo, the owner -builder will have the burden of proving that he did not build or improve for par. pose oriole.), ❑ L as owner of the property, am exclusively connecting with licensed contractors to arotmet the project (See. 7G4, Business and Prnfessimms Code:) the Cmanrelors LE - se law does not apply to an owner of property who bdilds or improves themon. and QTY, who commits for such projects with a commator(.$) licensed pummal to the Cormic m's License I.e.. ❑ I am exempt under Sec. ,B&PC forars ..,on Diviner Data WORKERS COMPENSATION DECLARATION 1 hemby affirm under penalty of perjury one of the following declarations: ❑ (have and will mainmin a Ceraficnc of Consent to self -insure for Workers Comped. sntion, as provided for by Section 3700 of the Labor Code, far the perfaonunce of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as requited by Section 3700 of the Labor Code, for the performance or the work for which this permit is Issued. My Worker', jRsIl�ili nn p I cy m��i�t Nn �� CI!RTIFI�ION FR MWORKERS' COMPENSATION INSURANCE! (This section need not he completed if the permit is for one hundred dollar (Slap or less) I candy last in tho perfnm+unee of the wnrl for which this permit is issucd,lsholl not employ nay Perron in any manner so as m become subject to the Workers' C,mpcm Q z sntion Laws of California. Date z Q Applicant ti NOTICE TO APPI.ICAM': II', after making this Ciamfame of Exemption, you should a> become subject to the Workers Compensation provisions of the Labor Code, you mud w forthwith comply with such provisions or this permit shall be chemical revoked. Q CONSTRUCTION LENDINGAGENCY L) k for rwhichithi thenhereissued(S .ion lending agency for the performance of W. E~ -a the work for which this permit is issued (Sec. 9097, Civ. C.) C) U Lender'., Name W Lenders Address 1 certify that I have read this application and come that he (claw, information is Ln u,nect. I agree to comply with A city and county ordinances and slum laws rdut'mg to QTY Li Z building construction. and hereby authorise representatives ofthis city to enter upon the above-mentioned property for inspection purposes. (W,) agree to -,ave, Indemnify and keep haendess the City or Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in asequence of the granting of this permit. APPLICANT UNDENSTANDS AND WILL COMPLY WITH ALL NON -POINT HAZARDOUS MATERIALS DISCLOSURE? Will the applicant or furore building occupant store or handle harardnus matenal as de@ted by the Cupenin, Municipal Code, Chapter 9,12, and the Health and Safety Code, Section 25532ho1 / o Yes Will the uppliwtn or future building oecupum use equipment or devices which mit hmallous air comaminams as defined by the Bay Amo Air Quality Management DisuiCl'1 0Yas 1 have reed the mountains materials requirements under Chapter 6.95 of the Cali- fornia Health & Safety Code, Sections 25505. 25533 and 25534. 1 undcmtmad that if the holdingsI I am j that it is my oophoodulity tonotify the,ccopum ofd. or whidl�(mmraat Tlortgyvumceofa Certificmeof Occuma .r ELECTRIC PERMIT PERMIT ISSUANCE APPLIANCES-RHSIDENI'IAL PANELS UPT0 200 AMPS 201d00OAMPS SIGNS ELECTRICAL SPECIAL CIRCUIT/MISC. TEMP. METER OR POLE INST. POWER DEVICES SWIMMING POOL ELECTRIC OUT1.H IS - SWITCHES - FIXTURES NEW RESIDENTIAL ELECIR PLUMBING PERMIT PERMIT ISSUANCE! ALTER - DRAIN & VENT -WATER (EA) BACK FLOW PROTECT. DEVICE DRAINS- FLOOR, ROOF, AREA, CONTI. FIXTURES -PCR I RAP GAS - CA. SYSTEM.] INC, 4 OUTLETS GAS -EA. SYSTEM -OVER 4 (EA) GREASE%INDUST RL WASTE INTERCEPTOR GREASETRAP SEWER - SANITARY -STORM EA. 200 FL WATER HEATER WNENTA!LECfR WATER SYSTEMn HEATING WATER SERVICE NEW RESIDENTIAL PLMB. SQ. ET. MECHANICAL PERM Ie,' PERMIT ISSUANCE ALTER OR ADD TO MECH, AIR HANDLING UNIT (TO 101.1100 CFM) ' AIR HANDLING UNIT (OVER 10,000 CFM) EXHAUST HOOD (W/DDC'D IIEATING UNIT CFO IW.000 BTU) I IEA'1'ING UNIT (OVER 110.000 BTU) VENTILATION FAN (SINGLE RESID) BOILER -COMP (3HP OR 100,000 BTU) BOILER -COMP (OVER 108,000 BTU) AIR CONDITIONER NEW RESIDENT Al. MECH. SQ. FT OFFICE tSQ. FT. FLOOR AREA �A8® F2EOCT 151996 13UILDINO DIVISION PI PLANCHECK FEE ENERGY FEE GRADING FEE SOILS FEE PAID Data Receipt# TOTAI,: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTIONTAN HOUSING MITIGATION PEE PAID Date Receipt BUILDING PERMIT INTO BLDG ELECT ❑ -5j�, PLUMB MECH ❑ ❑ FEE JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑KITCHEN REMODEL ❑ADDITION ❑ PLUMBING RE -PIPE , El MULTI -UNIT ❑STRUCTURAL MODIFICATION El INTERIOR ❑CHIMNEY REPAIR IMPROVEMENT ❑ BATH RF,MODEUREPAIR ❑ DEMOLITION ❑ OTHER COMMERCIAL: ❑NEWBL.DG/ADDITION ❑T17NANT IMPROVEMENT' ❑OTHER ❑DEMOLITION ❑ FOOD SERVICE tSQ. FT. FLOOR AREA �A8® F2EOCT 151996 13UILDINO DIVISION PI PLANCHECK FEE ENERGY FEE GRADING FEE SOILS FEE PAID Data Receipt# TOTAI,: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTIONTAN HOUSING MITIGATION PEE PAID Date Receipt